ders; three only perished, two of whom were generally out of the sea, but frequently overwhelmed by the surge, and at other times exposed to heavy showers of sleet and snow, and to a high and piercing wind.' Of these two, one died, after four hours' exposure; the second died three hours later, 'although a strong healthy man of twenty eight, a native of Scotland, in the flower of life, early inured to cold and hardship, and very vigorous both in mind and body.' The third that perished had been a weakly man. The remaining eleven who had been more or less completely submerged, were taken from the wreck next day, after twenty-three hours' exposure, and recovered. The person amongst the whole who seemed to have suffered least was a negro: of the other survivors, several were by no means strong men, most of them had been inured to the warm climate of Carolina.' In the case of the first two that perished the morbific power of the high piercing wind' was aided no doubt very powerfully by evaporation. In Dr. Currie's account of his experiments on the cold bath, we have the following interesting illustration of the superior refrigerant power of wind or air in motion. continuing in the water fifteen minutes, the subject of some of his trials exhibited 'little or no diminution of his heat in rising into the air in a perfect calm, though during a frost; while the like exposure in a second trial, under similar circumstances, but with a north-east wind blowing sharply, produced a rapid diminution (of animal heat), though the air was many degrees warmer' than in the preceding experiment. After I have above cited several examples of even death instantaneously produced by the chilling influence of a piercing north wind. Every valetudinarian is aware of the inconvenience and even danger of exposure to blasts from chinks and other apertures in rooms otherwise close. Prevention of Diseases of Cold. The remarks I have to make in this section will come under the head of Clothing, Exercise, Internal heat, or stimulating ingesta, and Diaphoretic Means, as hot diluents, bedheat, &c. Every considerable augmentation of refrigerant influence requires on the part of the subject exposed, proportionate precantionary means for the protection of health: these preventive measures must consist either of increased clothing or of the use of means capable of compensating for defect of personal coverings, by diminution of intrinsic organic susceptibility. The class of preventive means last alluded to, will be by and bye considered, under the heads of exercise and stimulating ingesta: at present I shall confine myself to the question of clothing. Transition from a tranquil into an agitated or progressive atmosphere, as from indoors into the open air, from the inside of a stage coach to the outside, &c., is accompanied with a great increase of the refrigerant power, which the frame has to encounter, and will, in many instances, above all if moisture be present, require additional protective covering. When the exposure is but short, or the weather is fine, or the constitution vigorous, and reactive energy therefore ample, such precaution, no doubt, will generally be quite unnecessary: yet those compensative conditions must be often want ing in a greater or less degree, and exposure, therefore, not provided against by appropriate internal or external means, will often prove hazardous, and sometimes fatal. In how many cases has phthisis been traced to an indiscretion of the sort now alluded to; to a journey on the top of a stage-coach in bad weather, or by night with insufficient clothing, &c. In how many instances have youth and accomplishment, and loveliness, fallen victims to the noxious influence of cool, perhaps damp out-of-doors atmospheres in passing from one rout to another, or returning from scenes of splendid riot to domestic solitude and repose. In passing from a state of activity or exertion to one of relative quietude, precautions are often required for security; such transitions occur when horse or foot exercise is exchanged for riding in an open carriage, or gestation on the water, and obviously demand the like precautions with transitions from walking, running, &c., to sitting, lying down, &c. But of all conditions that require provident measures, that of sleep stands most in need of them. In that condition the calorific function is less excited, less exposed to incidental stimulation from physical agents, or moral impulses, or muscular exertion, than in any other. Less heat is evolved; the body is much more readily chilled, the cutaneous functions more easily disturbed, and every derangement of internal parts, producible by frigorific impressions on the skin is more promptly effected. In the state of sleep, it is therefore, if ever, necessary to guard against exposure to cool moisture, currents of cool air, and every other cause of diseases of cold. All this is very plain, and is generally known, and requires no further notice. Before quit ting this topic, however, I would briefly enter my protest against the absurd and mischievous extreme to which many, perhaps most people, carry the use of woollen and other night clothing. It is common for females, in particular, who seldom, amongst the richer classes at least, know the comfort, the real luxury of woollen or chamois coverings for the shoulders, chest, feet, &c., and who wear below the knee, on the arms, upper part of the chest, neck, or head, either slight or no covering, to retire to sleep on beds of feathers, under half a dozen or more folds of one material or another, mostly woollen, and this in soft, nay even in summer weather, and with every avenue for fresh air, every door and window, closed, and bed-curtains perhaps drawn closely all around: from such violent transitions what wonder if inconvenience result! The sleep is more or less disturbed by dreams and feverish uneasiness; the strength is not properly recruited, and the sleeper awakes unnerved, languid, indolent, often hot or chilly, generally anorectic. Under such circumstances, a susceptibility of inconvenience and injury from cold, above the average, may reasonably be looked for, and will, I believe, seldom fail, if occasion offer, to shew itself. Nor is the relaxation attending long immersion in warm air the only disadvantage in such cases; for there is obviously the further one of long-continued respiration of an impure atmosphere to be taken into the account: a disadvantage of no trifling importance in the cases of such as retire early to small rooms, and emerge into daylight after protracted slumbers. Another point in which many fail, is the adaptation of clothing to season, weather, &c. No one questions the propriety of such adaptation in the abstract; but the number of those that commit the grossest errors on this subject in practice is enormous. What can be more obvious than the temerity of wearing the same kind and quantity of clothing in the heats of summer and frosts of winter; yet there are not wanting in the very first rank of the medical profession persons chargeable with such imprudence. I recollect very well the substance of an argument I once had with a fellow-traveller, an Austrian cadet, on his way through mountains in mid-winter, en voiture, from Vienna to Laybach. He obviously suffered inconvenience from want of warmer clothing, yet would not admit the propriety of adding even a flannel vest to his wardrobe. He considered it, he told me, 'militärisch,' soldier-like, to dispense with woollen undercoverings. A like answer would no doubt be given by many defaulters on this side of the water. Ladies would hold it to be feminine, gentlemen, manly, &c., to dispense with the extra under-clothing proper for winter and cold weather. But indolence, temerity, and fine breeding, are bad protectives against inclement seasons. Exercise. An observant individual can seldom fail to know when, from universal weakness or incidental exposure, he is in danger from external cold; and a provident man will easily, in general, foresee future exposure. When actually exposed, the great prophylactic is muscular exertion, and, if possible, locomotive exercise. RITTER'S advice is excellent, when he recommends that we should counteract the chilling influence of a draught or of a damp atmosphere, to which we are constrained to expose ourselves, by proportionably increased exercise in order that we may be enabled to compensate for the augmented expenditure of caloric by an increased evolution of it. The calorific power of general muscular exertion is such that, but for the antagonist frigorific power of cutaneous exhalation and vaporization, there can be no doubt that even moderate exercise would be incompatible with health, and that violent locomotive exertion would, in comparatively tranquil atmospheres at least, prove destructive of life. It is so great, that, duly persevered in, and aided by clothing sufficient to protect the skin and extremities from the immediate contact of an intensely cold air, it has been, on innumerable occasions, found sufficient to bear man harmless through the most formidable trials, as the narratives of Parry, Franklin, Scoresby, and many others, abundantly testify. Respecting the use of hot drinks and aliments at once nutritive and stimulant, before and during exposure, little need be said. All experience is in their favour; every traveller on our stage-coaches knows the protecting power of warm tea and coffee, punch, &c. ; there is even unequivocal experimental proof of the power of stimulant drinks to sustain the animal temperature under exposure. During my experiments on the cold bath, I found, in some trials with warm drinks and wine, (taken before immersion,) the sensation of cold little less lively indeed, and the access of shivering little retarded; but the pulse and heat under the tongue were much less reduced by the cold than in other trials made without such preparation. As a preparative, however, for protracted exposure to cold, &c., pure vinous liquors are obviously unsuitable means: the excitement they produce is transitory, and is followed by dangerous depression of calorific power: and their repeated and free use is, amongst other objections, liable to this, that it favours that somnolency which is one of the most perilous effects of cold. I have little doubt that the protective power of punch, negus, &c. is more owing to the hot water than to the pungent spirit. The fourth division comprises the means of cutting short incipient diseases of cold. On the supervention of chilliness and other symptoms, effects of recent exposure to cold, such as slight headach, horripilation, dejection of spirits, hoarseness, slight sore throat, coryza, lachrymation, cold feet, anorexia, lumbar pains, &c., we should have immediate recourse to the shelter of a warm bed; all solid aliment should be withheld; our only ingesta should be warm diaphoretic drinks. Diluted vinous liquors taken warm, such as weak hot punch or negus, are often excellent diaphoretics in such cases. But, in general, the alcoholic ingredients may be safely dispensed with, and when the excitement is considerable and headach is present, it cannot, without rashness, be recommended. The preceding measures are usually sufficient, if early enough employed, to cut short incipient derangements from cold. Where irritation is considerable, which is indicated by flying pains in the back and limbs, lively sense of cold, smart shivering, &c., opiates had better be employed in addition to the means already mentioned: for this purpose Ritter highly extols a combination of opium and camphor, two or four grains of the latter with from the eighth to a fourth part of a grain of the former every second hour, until the horrors, headach, pains, &c. shall have vanished or greatly declined. I have no doubt of the utility of such a combination; but pure laudanum or opium combined with warm diluents will probably be found fully as efficient. Dover's powder is also an excellent remedy. Another remedy, at once efficient and agreeable, is the common effervescing draught, containing half a scruple of nitre, a drachm (more or less) of the compound tincture of camphor, and in some cases half a drachm or more of nitrous æther, and as much of Hippo wine, to be repeated every third, fourth, or sixth hour. Where the feeling of cold, as evidenced by horripilation, rigors, &c. is lively, warm bathing, local or general, followed up by some of the remedies just proposed, is very proper. Prevention of disease is better than cure; it implies a more masterly degree of skill and power in the prescriber, and a smaller expense of care and vital power on the part of the sick. In practical medicine the first indication in dignity as well as time, is prevention in other words, the avoidance or counteraction, as far as possible, of morbific agencies; and when illness arrives, the employment, without loss of time, of the means best calculated to disperse the earlier groups of organic preternatural conditions or symptoms, and thus, by anticipation, get rid of the complications and difficulties so soon superinduced and accumulated upon primary simple and tractable derangements by the influence of sympathy and habit: with these views, I have thought it advisable to append to my observations on the morbid effects of cold, remarks on the circumstances that most favor the action of morbific cold, on the means best calculated to neutralize its agency, and on the remedies that should be employed after injurious exposure to prevent the establishment of any nosological effect or regular disease of cold: on the plan, as on the execution, it is the reader's province to decide." The whole monograph which would have well deserved a place in the Cyclopædia of Practical Medicine, or in Dr. Copland's Dictionary, contains the most convincing proofs of the author's learning, talents, and discrimination. Case 5. Abbé G., aged 65, had been first afflicted with headachs, while pursuing his theological studies; their severity had gradually increased in consequence of great anxiety and distress; he had thus suffered from these, more or less for forty years; they were always exasperated by study; the sight and hearing had become excessively sensitive to their stimuli; and even the sense of touch had acquired a morbid acuteness; he was subject to spasms of the face and arms, and to general muscular uneasiness. Baths with the affusions were ordered: and having taken about twenty, he began to experience much relief; he continued their use for a long time, and was at length almost completely made well. THIRD SERIES. Case 6. A lady had been in the habit of taking anodynes every night, in consequence of a painful disease. Her mental faculties had become much impaired, and when M. Recamier visited her, she was in a seminarcotic state. She was treated with the cold baths, with much temporary benefit, both to her bodily and mental health. Case 7. A man, aged 34, was brought to the hospital in the following state; he was quite insensible, and could not be roused to answer questions, or to take notice of any thing; the pupils were dilated; the breathing and pulse natural; and he could move his limbs freely. There was no reason to believe that he was intoxicated, as he had spent the preceding night with his family, who stated that he had not drunk any spirits, &c. &c. By the use of the tepid bath, with cold affusions to the head at the same time, he was immediately well. M. Recamier designates such a case stupor," or "spontaneous narcotism." FOURTH SERIES. nervous Case 8. A young lady had been much affected with the loss of an intimate friend; a headach, at first slight, and afterwards very severe, came on; leeches were applied behind the ears, but instead of relieving, they aggravated all the distress; the pulse became quickened, and the system feverish; the vision and hearing morbidly acute; and the whole surface of the skin, and also the organs of smell and of taste so exquisitely tender, that she complained of the coppery savour of the water, which was sprinkled on her head; the vessel in which the water was held, was of copper. On the first day of treatment, by Recamier, she had three baths with affusion; three also on the second; and two on the following three days; and then only one daily; their temperature varied from 73° to 77° F. that of the affusions was about 40° F. their duration was from 15 to 18 minutes. Good effects were speedily obvious, and a decided amendment appeared on the ninth day, from which time she rapidly recovered. FIFTH SERIES. Case 9. A young female was thrown into deep affliction by the death of her husband; she became quite lethargic, and continued so for 11 days, during which time she shewed no signs of consciousness, and appeared to be quite insensible to all outward impressions; the pulse was variable, but always quickened; food was introduced by the stomach-pump, but it was instantly rejected by vomiting; she had been blistered and well physiced, with no advantage. Dr. Recamier ordered a bath of 76° Fabr. combined with affusion of cooler water on the head. On being taken out of the bath, she appeared to have awoke from a deep sleep, and in some degree recognised her attendants, but took no notice of her late bereavement. The baths were continued for several days, till the catemina appeared and then they were discontinued; during the short interval of their presence the malady returned, but under a different form; instead of the uninterrupted lethargy, there was a double quotidian febrile paroxysm of a few hours' duration, during which the skin was so tender, that if merely touched convulsive movements of the limbs were induced. Subsequently cataleptic symptoms took the place of the preceding; and afterwards cardialgia and incessant vomiting were the most prominent distress. The state of the patient becoming thus more and more afflicted, recourse was again had to the baths, which were employed for about 15 or 20 minutes each time, and the cool affusion to the head for the last three or four minutes. This treatment was continued for a fortnight, and her health was then much benefitted. With the exception of a slight relapse, in consequence of the intermission of the bathing for a few days, the lady was eventually so restored to health, that the French reporter states that she was soon able to eat a "bifteack" of reasons able dimensions! |